What actually is mental health?
By Coral Forde
Through the research of many psychologists, society is starting to understand and accept a variety of mental health disorders that can impact individuals in different ways. In this post I will look into three forms of mental health disorders each from a different section of psychology.
Behavioural psychology is the process in which behaviourists believe behaviour is learnt. It is commonly argued that behaviour is learnt through Classical conditioning (C.C) and Operant conditioning (O.C) behaviourists believe that it is the past experiences and exposure to different stimulus with the environmental factors that develop individuals behaviour. A common. assumption of the behavioural approach is that learning happens through the process of conditioning and is all learnt the same way. A nominal behaviour is seen as the response to abnormal learning and that through the use of therapy, behaviours can be learnt by teaching new responses to stimulus.
Mowers two stage theory of OCD (1947) explains how both Classical conditioning (C.C) and Operant Conditioning (O.C) influence O.C.D. C.C is a where behaviourists believe that learning is done by direct association. Through Pavlov and his study on dogs, behavioural therapies were developed. Pavlov paired a neutral stimulus (N.S.) which was the sound of a bell, with an unconditioned stimulus (UCS) which was the food. The UCS triggered an unconditioned response (UCR) which was salivation. Over time and through repeat exposure, the dogs began to associate the NS with the UCS leading the dogs to salivate even when the UCS was not present. The sound of the NS became a conditioned stimulus (CS)and the response of salvation became the conditioned response CR.
(Classical conditioning simplified)
In OCD, for example if a young child developed a fear of contracting cancer from an aunt who had a favourite chair, the chair would potentially become the C.S through association of the aunt touching it. As the aunt touched more objects, more objects became C.S to a point where as the child grew up, the fear and association could lead her to feel contaminated when leaving the house. When coming home, the woman would take her clothes off and place them in special containers before washing herself with alcohol. Until she had done so she would experience intense anxiety and washing would relieve that to feel comfy.
The need to wash would incorporate the second stage of Mowers two stage theory (1947) with Operant Conditioning. (O.C) is believed that behaviour is learnt through displayed behaviour to receive rewards or avoid punishment. It is believed that if an individual received positive reinforcement (P.R) which is a reward or Negative reinforcement (N.R) which is where there is the removal of something bad, then the behaviour is likely to be repeated. This is the same case if someone would be punished for undesired behaviour, meaning they are less likely to repeat it. An association is made between behaviour and its consequences. Behaviourists argue that abnormal behaviour is caused by reinforcing it. Operant conditioning is present in the O.C.D case as her behaviour has led to satisfying results (P.R). This subsides the anxiety feeling for a short period of time. This is due to the O.C.D cycle of need, obsession, anxiety and relief, meaning that the behaviour is then repeated.
Through the process of extinction, it is believed that both forms of conditioning can be eliminated. Mowers two stage theory led to a basis for the first psychological OCD treatment by Victor Meyer (1966) whose techniques were developed by Edna Foa and is now known as the Exposure and Ritual prevention (ERP). Despite this. C.C and O.C explain how obsessions are maintained, however do not explain how they arise.
EPR therapy is considered a highly successful behavioural approach as it explores different ways to dealing with obsessional thoughts. Research suggests that 75% of participants are helped through ERP therapy ( Foa & Kodak, 1966). ERP can also be paired with Cognitive behavioural therapy (CBT) in which the cognitive aspect looks into how we think, whereas the behavioural therapy looks at how it affects what we do. In order to encourage extinction, systematic desensitisation (SD) could be encouraged. This is where the individual is gradually exposed to the feared situation whilst undergoing relaxation techniques. SD is also used for phobias and anxiety disorders. Although it can be a time consuming, it is also considered highly effective.
A strength of behavioural psychology is that it is a scientific approach with plenty of theories to support its findings, however this is debated as the experiments have low validity due to being carried out in an artificial environment.
Despite therapies being ineffective for disorders such as schizophrenia or depression, other disorders like O.C.D, the behavioural therapies are widely used and are successful. It is often found however that most behavioural therapies do not focus on the underlying causes but more on the symptoms. This could lead to the disorder still being present with just a better understanding of how to control it. Behavioural psychology also ignores the influence of genetic and biological factors.
Otherwise known as physiological psychology and bio psychology, biological. psychology is the study of the physical basis of human behaviour, emotions and mental processes. Biological psychology focuses on how behaviour is influenced by the brain and nervous system. An eating disorder is characterised as a variety of disturbed eating habits. Having an eating disorder can often lead to being unable to have a healthy relationship with food. A common misconception of an eating disorder is than an individual has to be skinny, however eating disorders can range from a Anorexia to binge eating. Although more common in females ages 13–17, men can also develop the illness (NHS 2018, 2018). Anorexia is an eating disorder in which the main focus is to keep as much weight off as possible. This can be achieved by excessive exercise and, or starvation. Another common eating disorder is bulimia. This is where an individual would sometimes loose control and eat a large quantity of food in a short amount of time. This would result in intense emotions of regret and guilt, often leading the individual to ‘splurge’ (make themselves sick). This extreme fluctuation can be extremely unhealthy. Not all eating disorders. symptoms will fit specifically in an eating disorder, but common signs to look out for include avoiding social situations that may involve food and changing eating patterns.
The nervous system consists of the brain and the spinal cord. Electric messages or signals are carried down the spine and into the peripheral nervous system. The PHN is divided into two sections; The somatic nervous system: controls voluntary movements of muscles and the automatic nervous system which controls parts of the body that operate unconsciously. For example, the heart.
The automatic nervous system is further broken down into two more sub branches which consist of the sympathetic branch which provides energy and the Parasympathetic branch which calms us down.
A modern assumption made is that human behaviour can be modified and explained by various hormones, genetics and evolution. It is argued that over the years, genes have had to adapt therefore modifying our behaviour. Due to the biological similarities, most biological studies are conducted using animal subjects. It is believed that through the use of animals, it can help us understand human behaviour better. When treating behavioural mental health disorders, medication is often used to treat it.
Studies suggest that some people with an eating disorder may suffer from hypothalamus dysfunction. This theory suggests that all animals have a set weight and food should be regulated to fit that mould. It is believed that the lateral hypothalamus (LH) is the ‘feeding switch’ telling a person when to eat, compared to the ventromedial hypothalamus (VMH) which sends signals to stop eating. Garfinkel and Gardner (1982) believe that a disturbed or broken LH or VMH can cause an unintended eating disorder due to the wrong signals being sent down the nervous system. Further research with rats have shown that an overactive VMH results in reduced eating habits.
Other studies suggest that stress can also be a factor in changes to our behaviour. Stress is a response when individuals can not cope with everyday stressors. Hans Selye (1930) general adaption syndrome suggests that illness can be caused by stress. Hans Selye was researching the effects of hormones when he noticed that rats would become ill even when injections were harmless. He then identified a three stage physiological process called. the general adaptation syndrome (GAS). The alarm stage is where the body identifies the stressor. This then kicks in the fight, flight and freeze response. Physical changes take place which include an increased heart rate, tense muscles and higher rate of breathing. If a stressor is not resolved immediately the body begins to adapt to it. This then damages the immune system. This is called the Resistance stage. However the body soon goes into the exhaustion stage after there is long term exposure. The body becomes weakened, which increases the chances of high blood pressure and depression.
Biological psychology is a scientific approach and is able to provide evidence to support relevant theories. Also once a biological factor is identified in regards to mental health, biological treatments like antidepressants can be developed. However, although treatments can be effective, biological treatments do not take into account environmental factors or influences. By using the biological explanations to justify unwanted behaviour, it can lead to individuals avoiding personal responsibility.
In order to treat an eating disorder, it can take a long period of time and often requires a round the clock care plan specific to each individual, this would usually include a psychological aspect. It is not known specifically what causes eating disorders, however it is argued that it can be developed if a family member has a history of mental health issues, have received negative comments about their appearance and also if there is pressure from society or a job to look good. It is also believed that victims of abuse develop eating disorders in order to regain control over an aspect of their life.
Depression is defined as a state of health that causes people to feel a loss of interest and pleasure whilst leading to stronger feelings of intense emotions, hopelessness and anxiety (Mental Health Foundation, 2018). It is argued that depression is linked to suffering illness, bereavement and other life changing experience. Depression can develop at any stage in life. Although this suggests that environmental factors play a large role in the development of depression, chronic illnesses such as heart disease, back pain and cancer are argued to be a cause of depression.
Many theorists believe that the human mind works more like a computer and is able to input, store and receive data. The process of Cognitive psychology (C.P) argues that each individual is an active processor for information. C.P argues that it is the way data is perceived and interpreted that impact behaviour the most. The cognitive approach focus’s on individuals beliefs compared to their behaviour. Depression stems from negative bias in the thought process, resulting in a cognitive abnormality. Depression is understood as an inward directed anger and Sever super ego demands (Freud, 1917) and an loss of self esteem (Bibring, 1953; Fenichel, 1968).
Beck (1967) found that people suffering from depression looked at things in a more negative manner. Beck (1967) identifies three key points that he believed was responsible for depression. The cognitive triad is where the individual thinks negatively about themselves, the world and the future. It is believed that these thoughts are spontaneous. As the three factors interact, the normal cognitive processors like perception and memory are affected. Beck (1967) argues that a depressed individual develops a negative self schema (factor two) where they hold expectations of themselves but are pessimistic. It is believed that the negative schema is acquired during childhood after a traumatic experience such as death. His third factor identified errors in logic. This is where their thinking focus’s selectively on only certain aspects of a situation, ignoring relevant information. These thought patterns can lead to intense anxiety and depression.
To test this theory, Alloy et al (1999) followed the thought patterns of young Americans in their twenties for six years. By dividing the group into ‘positive thinkers’ and ‘negative thinkers’ they were able to identify that 1% of positive thinkers developed depression compared to 17% of the negative thinkers. This suggests there may be a link to cognitive styles and the development of depression.
Another theory behind depression is learned helplessness, which Martin Seligman (1974) provides a cognitive explanation. According to the theory, depression occurs when an individual can not escape a negative situation. Through the use of dogs Seligman witnessed that dogs who were harnessed soon stopped trying to escape their electrified cages whereas the dogs who were not harnessed also gave up after a longer period of time. The dogs then showed signs of depression such as loss of appetite and sluggishness.
However, although the theory explains depression it does not take into account the thought process. Also Gotlib and Colby (1987) argues that those who are depressed showed no differences to the non-depressed when assessing a helpless situation. This could suggest that helplessness is a symptom rather than a cause (Lewinsohn, 1981)
When aiming to treat depression through cognitive psychology, it is believed that CBT is the most effective method. The cognitive aspect focus’s on how we feel with the behavioural aspect focus’s on how the behaviour changes. In theory, how our feelings affect our actions. CBT aims to develop alternative ways of modifying both thinking and behaviour patterns to reduce stress. CBT is a combination of many therapies that are similar including Rational Emotive Behavioural Therapy (REBT) developed by Albert Ellis (1950) and Cognitive theory (Beck, 1967).
CBT can be beneficial because it focus’s on human thoughts. By changing a thought process, it is argued that it will also change behaviour. Cognitive therapy has shown to be effective for treating depression (Hollon & Beck, 1994) and also for anxiety (Beck, 1993). However, it has not yet been determined if cognitions are caused by psychopathology or is a consequence.
Cognitive psychology is beneficial when trying to understand how the brain operates and it’s potential limitations. It is believed that the results are reliable as the experiments can be repeated. The therapies developed through cognitive psychology are often fast acting and have little side effects. However, cognitive psychology ignores the influence of emotions and pressures. from other individuals, therefore does. not represent psychological and behavioural processors effectively. Also it does not take into account that each individual is different and processes information in different way.
In conclusion, although there is further understanding to these mental health disorders and how they impact an individual, not all forms of psychology can be beneficial to the disorder.
*please note this post is a version of a paper I submitted during education*
Abramson, L. Y., Seligman, M. E., & Teasdale, J. D. (1978). Learned helplessness in humans: critique and reformulation. Journal of abnormal psychology, 87(1), 49.
Alloy, L. B., Abramson, L. Y., Whitehouse, W. G., Hogan, M. E., Tashman, N. A., Steinberg, D. L., … & Donovan, P. (1999). Depressogenic cognitive styles: Predictive validity, information processing and personality characteristics, and developmental origins. behaviour research and therapy, 37(6), 503–531.
Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, Alazraki A, Selin CE, Ferng HK, Munford P, et al. (1992). “Caudate glucose metabolic rate changes with both drug and behaviour therapy for obsessive-compulsive disorder,” Archives of General Psychiatry, 49(9) 681–689.
Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.
Beck, A. T., Epstein, N., & Harrison, R. (1983). Cognitions, attitudes and personality dimensions in depression. British Journal of Cognitive Psychotherapy.
Beck, A. T, & Steer, R. A. (1993). Beck Anxiety Inventory Manual. San Antonio: Harcourt Brace and Company
Butler, A. C., & Beck, J. S. (2000). Cognitive therapy outcomes: A review of meta-analyses. Journal of the Norwegian Psychological Association, 37, 1–9.
Brown, G. W., & Harris, T. (1978). Social origins of depression: a reply. Psychological Medicine, 8(04), 577–588.
Chodoff, P. (1972). The depressive personality: A critical review. Archives of General Psychiatry, 27(5), 666–673.
Dobson, K. S., & Block, L. (1988). Historical and philosophical bases of cognitive behavioural theories. Handbook of Cognitive behavioural Therapies. Guilford Press, London.
Ellis, A. (1957). Rational Psychotherapy and Individual Psychology. Journal of Individual Psychology, 13: 38–44.
Ellis, A. (1962). Reason and Emotion in Psychotherapy. New York: Stuart.
Fenichel, O. (1968). Depression and mania. The Meaning of Despair. New York: Science House.
Freud, S. (1917). Mourning and melancholia. Standard edition, 14(19), 17
Foa E B. and M J Kozak (1996). Psychological treatment for obsessive-compulsive disorder In Long-term Treatments of the Anxiety Disorders.Edited by M R Mavissakalian and R F Prien, Washington, DC. American Psychiatric Press.
Gotlib, I. H., & Colby, C. A. (1987). Treatment of depression: An interpersonal systems approach. Pergamon Press.
Hollon, S. D., & Beck, A. T. (1994). Cognitive and cognitive-behavioural therapies. In A. E. Bergin & S.L. Garfield (Eds.), Handbook of psychotherapy and behaviour change (pp. 428 – 466). New York: Wiley.
Kendall, P. C., & Kriss, M. R. (1983). Cognitive-Behavioural interventions. In: C. E. Walker, ed. The handbook of clinical psychology: theory, research and practice, pp. 770 – 819. Homewood, IL: Dow Jones-Irwin.
Klein, M. (1934). Psychogenesis of manic-depressive states: contributions to psychoanalysis. London: Hogarth.
Lewinsohn, P. M., Steinmetz, J. L., Larson, D. W., & Franklin, J. (1981). Depression-related cognitions: antecedent or consequence?. Journal of abnormal psychology, 90(3), 213.
Lyons, L. C., & Woods, P. J. (1991). The efficacy of rational-emotive therapy: A quantitative review of the outcome research. Clinical Psychology Review, 11(4), 357–369.
Maslow, A. H. (1962). Towards a psychology of being. Princeton: D. Van Nostrand Company
McLeod, S. A. (2015). Cognitive behavioural therapy. Retrieved from www.simplypsychology.org/cognitive-therapy.html
Meyer V (1966). “Modification of expectations in cases with obsessional rituals.” Behaviour Research and Therapy. 4:273–280
Mower H O (1947). “On the dual nature of learning – A re-interpretation of “conditioning” and “problem-solving.” Harvard Educational Review, 17:102–148.
Rimm, D. C., & Litvak, S. B. (1969). Self-Verbalisation and emotional arousal. Journal of Abnormal Psychology, 74(2), 181.
Seligman, M. E. (1973). Fall into helplessness. Psychology today, 7(1), 43–48.
Seligman, M. E. (1974). Depression and learned helplessness. John Wiley & Sons